Tattoo Removal – More than Skin Deep

Marking the human body with ink is a centuries-old practice by many cultures around the world to symbolize belonging, status or an accomplishment. Tattoos have been used to ward off evil spirits, as a memorial or more practically, to hide a scar. They may be simple geometric shapes or panoramic images. They can be found almost anywhere on the body.

These days, “tats” are popularly considered to be art. The colors and complexity are often striking, but in some groups “ink” can have negative associations. That’s why in partnership with the San Diego County Probation Department and the San Diego County Indigent Criminal Defense Grant Fund, the UC San Diego Clean Slate Tattoo Removal Program was launched in February.
“Although tattoos have become more normalized, folks who have what are considered anti-social images or text marked on their bodies are not always viewed positively,” said Victoria Ojeda, PhD, associate professor in the Division of Global Public Health at University of California San Diego School of Medicine. “Couple this stigma with an individual who is released from jail or related to a gang, and you have a negative perception that may create problems for persons who are re-entering society.”
Ojeda also co-directs the Health Frontiers in Tijuana (HFiT) Clinic, which provides free laser tattoo removal for deported migrants who are seeking to reintegrate into the community. The UC San Diego Clean Slate Tattoo Removal Program builds upon HFiT Clinic’s success. Preliminary data from a randomized trial suggests that the service has helped migrants improve their health and other social outcomes, such as finding employment and reducing the likelihood of repeat incarceration over the study period.
Ojeda, along with Arisa Ortiz, MD, director of laser and cosmetic dermatology at UC San Diego Health, started the free program in San Diego to help people in the county’s South Bay probation program transition out of the justice system by physically removing at least one source of social stigma.
“Ex-gang members and troubled youth who are trying to assimilate into society have trouble obtaining jobs or even entering the military because their tattoos are associated with social stigmas,” said Ortiz. “By removing tattoos, we can help them jump-start a new life.”
Permanent tattoos are created using ink that is inserted into the dermis — the layer just below the surface of the skin that is visible to the eye, called the epidermis. The process damages the epidermis, eliminating the skin’s natural pigment and allowing the dye that is trapped in cells just below the dermis to fill in the color.
Removing indelible ink is difficult, requiring anywhere from six to 12 laser treatments. Two months between each session allows the skin to heal and the body to clear dye particles destroyed by the laser. Amateur tattoos are easier to remove because professionals use more color, and multicolor marks require different lasers, said Ortiz.
The laser Ortiz and her team use at UC San Diego Health has three wavelengths to treat different hues. Each session reduces color saturation by five to 15 percent in just five to 10 minutes for smaller tattoos and 15 to 30 minutes for larger ones.
“We try to focus on tattoos that are most visible first, like those of the hands or face,” said Ortiz. “Often the tattoo can be completely removed, but patients should be aware that, in some cases, the tattoo might cause a skin irregularity that is revealed by the removal.”
The UC San Diego Clean Slate Tattoo Removal Program treats approximately 10 patients each month, all referred by the county probation office.
But tattoo remorse isn’t unique to any particular group. Ortiz also sees patients who have simply changed their mind about their tattoos, such as lip liner tattoos. She notes that red tattoos can turn black. Red, white and yellow dyes are stubborn colors that may not respond as well to laser treatment without proper precautions.
“Patients should be aware of potential complications with tattoo removal, like an allergic reaction,” said Ortiz. “This condition should be pre-treated with medication so that as the body tries to clear the ink after laser treatment, the reaction isn’t spread throughout the body.”
Tattoos can also camouflage other underlying issues, such as skin cancer. Ortiz suggests having tattoos removed by a trained professional who can diagnose medical problems and ask appropriate questions about previous treatments.
For example, gold infusion was once used to treat rheumatoid arthritis. If a patient who has had gold infusion treatment undergoes laser tattoo removal, the skin can turn blue and be difficult to remove.
“This is your skin and future so get the best possible care that will set you on the most successful path,” said Ortiz.